Without prescription steroids are a bane, beware

Thirty one-year-old Kamla Devi had been using a common skin ointment for her pimples for a long time but now they have turned bigger, spread all over her face, neck and started bleeding. She stopped using the ointment, but it aggravated the rashes even further.

Her condition is pitiable and finally diagnosed as Topical Steroid Damaged Face (TSDF) which is triggered by steroids in skin ointments. Indiscriminate use of such creams have effected more than thousands of people across India. They are suffering from the disease which is not fatal but can't be cured completely.

A study released at Dermacon 2012, by a group of dermatologists representing the confrence, reveal that 15 lakh people are suffering from TSDF. The survey was done in Chennai, Lucknow, Baroda, Pune, Udaipur, Dibrugarh and Coimbatore. It showed that most patients had used steroid-laden ointments like Betnovate C and N, Tenovate, Lobate or Quadriderm which are available without a prescription and easily available over the counter at local pharmacist shops. "These medicines have a high steroid content that may turn the skin thinner, give rise to steroid dependence and enhance pimples or rashes for which you might have been using them.

Other serious complications like hirsutism (unwanted hair growth on face in women), perioral dermatitis or rosacea can also prop up. Unfortunately these creams and ointments are available over the counter without a prescription, which is not the case anywhere else in the world," said Dr Vijay Arora, Consultant physician and former CMO at Safdurjung Hosptial.

"People commonly used such steroid born to cure eczema and proriasis but try to use in controlled way. Steroids are a boon to medical science. It was made to cure some complicated disease. Using a salt like betamethasone valerate, clobetasol propionate without the doctor permission can cause damage to your skin. These salt carrying tubes are sold like hot cakes in the market and since they come under the umbrella of DPCO (Drug Price Control Order) they are available at nominal price. So the misuse becomes more rampant," revealed Dr US Aggarwal, Head of the Department, Dermatology, Sawai Man Singh hospital, Jaipur. Out of the number of patients that visited SMS hospital daily 10-15 were diagnosed with steroid disorder, he added.

Drug rules prohibit over-the-counter sale of topical steroids internationally and some of them even in India but only on papers, therefore, there is no prescribed treatment for this problem in India. "We have been groping in the dark and have been forced to devise our own treatment regime based on experience. Generally, we taper off the ointments rather than taking them off in a go for that leads to withdrawal effects on the skin. It is similar to the de-addiction or rehabilitation programme that drug addicts go through. But the treatment norms are still evolving," added Dr Punit Bhargava, a Jaipur, based dermatology consultant.

If your skin disorders are mild, you can buy steroid creams available over the counter. But bear in mind that steroid creams can make certain skin conditions worse and should not be used on some parts of the body. If you are not sure whether certain cream is not suited to you or your child's skin it is best to ask the pharmacist's advice or see your General Practitioners before using any steroid cream.